Asymmetrical density heel raises

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<ADMIN NOTE> Thie thread was split from the Foot Orthoses Seminar thread

Craig, would you mind explaining again about the use of heel raises of different densities, when to use, why it works etc. I just didn't understand it from your seminar.


Many thanks

 

What I said at the seminars and do is use 3mm poron heel raise in one foot and a 3mm rigid polypro heel raise under the other when either:
1. The velocity of centre of pressure is asymmetrical under the rearfoot between the two feet
or
2. On video gait analysis there is an asymmtry in the timing of heel lift between the two feet
(both are essentailly measuring the same thing).

The poron causes a slight slow down in the heel raise and the velocity of CoP and the polypro speeds it up --> more symmetrical gait (this may be a factor in gait induced postural problems).

 

I tried this on a patient just after I heard CP talk about it. Patient had big difference betweeb timing of heel lift between feet. They presented with heel pain which the orthotics worked well on. The sacro-iliac pain they had did not go away until I did just what CP suggested.

 

Hi Craig and DaVinci,

Do you use video gait analysis to see these differences or are they noticable to the naked eye?

Rebecca

 

The best way is to use in-shoe pressure measurement, then you can see if the aymmetrical material density has altered the asymmetry (it does not always work for some reason).

On a digital video, I advance one frame at a time until the heel of the front foot hits the ground (either on a sagittal or frontal view), then note the approx height that the trailing heel is off the ground .... advance video until heel contact of the contralateral foot - then note the height the heel is of the ground of the trailing leg. Is it the same as the other? It also pays to check several steps.

I would suspect that to the naked eye it would be difficult, if not impossible to see.

 

Nup, still don't get it ... sorry.

I've just got Siliconcoach set up and videoed the family's gait, its very exciting. The high gear / low gear I fully understand. Its the heel lift timing I don't understand.

First of all, heel lift can be early, normal or late. What defines these points as far as video gait analysis is concerned?

And in regard to the poron and poly, its not clear to me which you use when. Can somebody please explain?

Thanks

Rebecca

 

It seems to be more the symmetry of timing of heel off thats important. Look at the frame where the leading heel hits the ground. How far is the contralateral heel off the ground at that stage - check several steps --- compare the two sides.

Having said symmetry is important, it is often a very fatiguing gait if the heel is not off the ground when the contralateral heel contacts the ground. The more the heel is off the ground at contralateral heel strike, assume that its possibly a more efficient gait

 

So its important that left and right heel off is symmetrical.

So what is the treatment when:
1. right heel off is earlier than left heel off
2. right heel off is later than left heel off

This would be termed an apropulsive gait?

OK, so you're saying an early heel off is more efficient than a delayed heel off, I get that. Is there a reference point to show where heel off is late, normal and early?

So what is the treatment when:
1. right heel off is late
2. right and left heel off is late
3. right heel off is early
4. right and left heel off is early

Thanks for your help.
Rebecca

 

That is the assumption. There is no reason to doubt it not a good assumption. Certainly do see patients with postural symptoms that are asymetrical (but also see a lot that are not), so no good data to back up assumption, except anecdotal clinical experience.

Softer heel raise under right and harder heel raise under left

Softer heel raise under right and harder under left. This is also based on the assumption that there is nothing proximal that might be causing this, such as some sort of SI dysfunction.

Yes, but you will soon start seeing a lot who the heel only just get off the ground at the time of contralateral heel contact - that still has to not be good.

No. We still trying to get an understanding of it.

The rule of thumb is harder material to make it happen quicker and a softer material to slow it down.

All this is much easier to visualise with in-shoe pressure, so hopefully Bruce Williams stops by and comment.

 

Another way to look at it - if the timing of heel off is asymmetrical, you are theroretically going to walk in a circle as one side is moving faster than the other. The only way to stop walking in a circle if for the proximal muscles to work asymmetrically to keep correcting it --> proximal and postural problems.

 

OK thanks Craig ... I'm almost there.

So if one heel off is early (or late) and the other is normal, why put anything under the normal one?

Rebecca

 

I have no idea why - I just do it that way.... still learning about this though

 

Hi Craig,

Apologies that I'm a bit late into this thread - it must have passed me by the first time

Just wondered if having heel raises of different materials/densities had any ramifications with respect to introducing a functional leg length discrepancy?

Ian

 

Nope. 3mm polypro vs 6mm poron

 

Oh sorry - in post #2 it read as 3mm bilaterally; thanks for the clarification

Ian

 

Hi

i'm sure there are some nice pictures of this on the forum somewhere...but i can't find them anywhere!

Anyone [Craig ] point me in the right direction please?

Merry Christmas!

:santa:

Rob

 

We do not use these products in Holland. Can you give the shore values of these materials?

 

Hi Craig,

Instead of adding a heel raise on both feet (3mm and 6mm poron or 3mm poron and 3mm polypro), is it possible to just add a heel raise on one foot (4mm poron on early heel life foot or 2mm polypro on late heel lift foot)?

 

You don't want to create a leg length difference, hence 6mm poron=3mm polyprop.

 

Wouldn't a 3mm poron and 3mm polypro create a leg length difference? Or is it too small to be insignificant?

 

I not sure 3mm poron would be sufficient to get an effect.

If you have access to in-shoe pressure, test someone with 3mm and 6mm poron and see what happens to the velocity of the CoP.

You probably right though about 3mm poly vs 3mm poron, its only going to create a LLD of 1-2mm ... maybe not significant.